Extracurricular Activity Safety Training Program

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Extracurricular Activity Safety Training Program

• 2008-2009

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Section 1

• Sudden Cardiac Death

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Basic CPR (this does not qualify as
certification)
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What is Sudden Cardiac Death?

• Sudden cardiac death is an abrupt occurrence
  where the heart ceases to function and results in
  death within minutes.
• It is not a heart attack.
• It is usually due to a malfunction of the heart's
  electrical system that coordinates the heart
  muscle contraction to pump blood through the
  body. The lower chambers (ventricles) of the
  heart go into fibrillation (ventricular
  fibrillation) - a fast and disorganized
  contraction. The ventricles spasm or quiver and
  can no longer pump blood to the body. The heart
  cannot recover from ventricular fibrillation on
  its own.
• Sudden cardiac death in athletes is usually
  caused by a previously unsuspected heart disease
  or disorder.
• The occurrence of sudden cardiac death is thought
  to be in the range of 1 out of 100,000 to 1 out
  of 300,000 high school age athletes. So it is
  very rare.

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Possible Causes of Sudden Cardiac Death

• Hypertrophic Cardiomyopathy - a condition where
  the muscle mass in the left ventricle
  "hypertrophies". The thickened heart muscle can
  block blood flow out of the heart and can
  increase the risk of ventricular fibrillation. In
  over half of the cases, this heart disorder is
  hereditary and is most common in young adults.
  This is the most common cause for sudden cardiac
  death in athletes in the United States.
• Coronary Artery Abnormalities - an abnormality of
  the blood vessels that supply blood into the
  heart muscle. This is present from birth, but can
  be silent for years until very vigorous exercise
  is performed. During exercise, blood flow to the
  heart muscle can be impaired and result in
  ventricular fibrillation.
• Commotio Cordis - a concussion of the heart that
  can occur when someone is hit in the chest in the
  area of the heart. Objects such as a baseball,
  softball, hockey puck, lacrosse ball, or even a
  fist can cause ventricular fibrillation upon
  striking the chest. These injuries are rare.

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Possible Causes of Sudden Cardiac Death, Cont.

• Marfan Syndrome - an inherited abnormality of the
  connective tissue (ligaments and tendons) in the
  body. Often these people are tall and thin with
  long arms, legs, fingers and toes. The wall of
  the aorta, the main artery from the heart, can
  become weak and rupture, especially during
  exercise.
• Wolff-Parkinson-White Syndrome - an extra
  conduction fiber in the heart that can allow for
  rapid heart beat episodes and in some cases
  ventricular fibrillation can occur.
• Long QT Syndrome - an inherited abnormality of
  the heart's electrical system. Episodes of rapid
  heartbeat can occur in the bottom chambers of the
  heart (ventricles) and ventricular fibrillation
  can result.
• Recreational Drug Use - even someone with a
  completely normal heart can develop ventricular
  fibrillation and die suddenly due to drug use.

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Warning Signs of Sudden Cardiac Death

• Palpitations - feeling fast or skipped heart
  beats.
• Dizziness - feeling lightheaded.
• Chest pain or chest tightness with exercise.
• Shortness of breath.
• Syncope - fainting or passing out.
• Family history of sudden cardiac death at less
  than age 50.

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Section 2

• Head and Neck Injuries

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Reducing Head and Neck Injuries

• 1. Preseason physical exams for all participants.
  Identify during the physical exam those athletes
  with a history of previous head or neck injuries.
  If the physician has any questions about the
  athlete's readiness to participate, the athlete
  should not be allowed to play.
• 2. A physician should be present at all games. If
  it is not possible for a physician to be present
  at all games and practice sessions, emergency
  measures must be provided. The total staff should
  be organized in that each person will know what
  to do in case of head or neck injury in game or
  practice. Have a plan ready and hour your staff
  prepared to implement that plan. Prevention of
  further injury is the main objective.
• 3. Athletes must be given proper conditioning
  exercises, which will strengthen their necks so
  that participants will be able to hold their head
  firmly erect when making contact.
• 4. Coaches should drill the athletes in the
  proper execution of the fundamentals of football
  skills, particularly blocking and tackling.

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Reducing Head and Neck Injuries, Cont.

• 5. Coaches and officials should discourage the
  players from using their heads as battering rams.
  The rules prohibiting spearing should be enforced
  in practice and in games. The players should be
  taught to respect the helmet as a protective
  device and that the helmet should not be used as
  a weapon.
• 6. All coaches, physicians, and trainers should
  take special care to see that the player's
  equipment is properly fitted, particularly the
  helmet.
• 7. Strict enforcement of the rules of the game by
  both coaches and officials will help reduce
  serious injuries.
• 8. When a player has experienced or shown signs
  of head trauma (loss of consciousness, visual
  disturbances, headache, inability to walk
  correctly, obvious disorientation, memory loss)
  he should receive immediate medical attention and
  should not be allowed to return to practice or
  game without permission from the proper medical
  authorities.

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Keep the Head Out of Football

• Rules changes that eliminated the head as the
  initial contact point in blocking and tackling
  have significantly reduced head and neck injuries
  in the sport.
• Coaches can do their part to continue that trend
  by teaching correct techniques and emphasizing
  proper fundamentals at all times. That way,
  players can avoid catastrophic injury.

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Signs and Symptoms of Mild Head Injury

• Headache
• Nausea
• Balance problems or dizziness
• Double or fuzzy vision
• Sensitivity to light or noise
• Feeling slowed down
• Feeling "foggy" or "not sharp"
• Change in sleep pattern
• Concentration or memory problems
• Irritability
• Sadness
• Feeling more emotional

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Signs of Concussion

• Concussions can appear in many different ways. To
  follow are some of the signs and symptoms
  frequently associated with minor head trauma
  (e.g., "ding", "bell rung", dazed or concussion).
  Most symptoms, signs and abnormalities after a
  head injury fall into the four categories to
  follow. A coach or other person who knows the
  athlete well can usually detect these problems by
  observing the athlete and/or by asking a few
  relevant questions to the athlete, referee or a
  teammate who was on the field or court at the
  time of the head injury. Below are some suggested
  observations and questions a non-medical
  professional like a coach or school administrator
  can use to help determine whether an athlete has
  suffered a concussion and how urgently he or she
  should be sent for medical care following a head
  injury.

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Signs of Concussion, Cont.

• PROBLEMS IN BRAIN FUNCTION
• a. Confused state dazed look, vacant stare,
  confusion about what happened or is happening.
• b. Memory problems Can't remember assignment on
  play, opponent, score of game, or period of the
  game. Can't remember how or with whom he or she
  traveled to the game, what he or she was wearing,
  what was eaten for breakfast, etc.
• c. Symptoms reported by athlete Headache,
  nausea or vomiting, blurred or double vision,
  oversensitivity to sound, light or touch, ringing
  in ears, feeling foggy or groggy.
• d. Lack of Sustained Attention Difficulty
  sustaining focus adequately to complete a task or
  a coherent thought or conversation.

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Signs of Concussion, Cont.

• SPEED OF BRAIN FUNCTION Slow response to
  questions, slow slurred speech, incoherent
  speech, slow body movements, slow reaction time.
• UNUSUAL BEHAVIORS Behaving in a combative,
  aggressive or very silly manner, or just atypical
  for the individual. Repeatedly asking the same
  question over and over. Restless and irritable
  behavior with constant motion and attempts to
  return to play or leave. Reactions that seem out
  of proportion and inappropriate. Changing
  position frequently and having trouble resting or
  "finding a comfortable position." These can be
  manifestations of post-head trauma difficulties.
• PROBLEMS WITH BALANCE AND COORDINATION Dizzy,
  slow clumsy movements, acting like a "drunk,"
  inability to walk a straight line or balance on
  one foot with eyes closed.

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Second-Impact Syndrome

• Second-impact syndrome is a rare event, which
  poses a significant concern for athletes who
  return too soon after suffering a previous
  concussion. Second-impact syndrome is
  characterized by an autoregulatory dysfunction
  that causes rapid and fatal brain swelling, and
  can result in death in as little as two to five
  minutes. It is particularly important to note
  that virtually all of the second-impact syndrome
  cases that have been reported have occurred in
  adolescent athletes. The progressive signs of
  second-impact syndrome are as follows
• Previous history of concussion
• Visual, motor or sensory changes
• Difficulty with memory and/or thought process
• Collapse into coma
• Signs of cranial nerve and brainstem pressure

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Section 3

• Heat, Hydration and Asthma

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Heat Stress and Athletic Participation-Symptoms

• Heat Cramps - Painful cramps involving abdominal
  muscles and extremities caused by intense,
  prolonged exercise in the heat and depletion of
  salt and water due to sweating.
• Heat Syncope - Weakness, fatigue and fainting due
  to loss of salt and water in sweat and exercise
  in the heat. Predisposes to heatstroke.
• Heat Exhaustion (Water Depletion) - Excessive
  weight loss, reduced sweating, elevated skin and
  core body temperature, excessive thirst,
  weakness, headache and sometimes unconsciousness.
• Heat Exhaustion (Salt Depletion) - Exhaustion,
  nausea, vomiting, muscle cramps, and dizziness
  due to profuse sweating and inadequate
  replacement of body salts.
• Heatstroke - An acute medical emergency related
  to thermoregulatory failure. Associated with
  nausea, seizures, disorientation, and possible
  unconsciousness or coma. It may occur suddenly
  without being preceded by any other clinical
  signs. The individual is usually unconscious with
  a high body temperature and a hot dry skin
  (heatstroke victims, contrary to popular belief,
  may sweat profusely).

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Heat Stress and Athletic Participation-Treatment

• Know what to do in case of emergency and have
  your emergency plans written with copies to all
  your staff. Be familiar with immediate first aid
  practices and prearranged procedures for
  obtaining medical care, including ambulance
  service.
• Heat Stroke - This is a medical emergency. DELAY
  COULD BE FATAL.
• Immediately cool body while waiting for
  transfer to a hospital. Remove clothing and place
  ice bags on the neck, in the axilla (armpit), and
  on the groin area.
• Heat Exhaustion - OBTAIN MEDICAL CARE AT ONCE.
• Cool body as you would for heat stroke
  while waiting for transfer to hospital. Give
  fluids if athlete is able to swallow and is
  conscious.
• Summary - The main problem associated with
  exercising in the hot weather is water loss
  through sweating. Water loss is best replaced by
  allowing the athlete unrestricted access to
  water. Water breaks two or three times per hour
  are better than one break an hour. Probably the
  best method is to have water available at all
  times and to allow the athlete to drink water
  whenever he/she needs it. Never restrict the
  amount of water an athlete drinks, and be sure
  the athletes are drinking the water. The small
  amount of salt lost in sweat is adequately
  replaced by salting food at meals. Talk to your
  medical personnel concerning emergency treatment
  plans.

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Recommendations for Hydration

• HYDRATION TIPS AND FLUID GUIDELINES
• Drink according to a schedule based on
  individual fluid needs.
• Drink before, during and after practices
  and games.
• Drink 17-20 ounces of water or sports
  drinks with six to eight percent CHO, two to
  three hours before exercise.
• Drink another 7-10 ounces of water or sport
  drink 10 to 20 minutes before exercise.
• Drink early - By the time you're thirsty,
  you're already dehydrated.
• In general, every 10-20 minutes drink at
  least 7-10 ounces of water or sports drink to
  maintain hydration, and remember to drink beyond
  your thirst.
• Drink fluids based on the amount of sweat
  and urine loss.
• Within two hours, drink enough to replace
  any weight loss from exercise.
• Drink approximately 20-24 ounces of sports
  drink per pound of weight loss.
• Dehydration usually occurs with a weight
  loss of two percent of body weight or more.

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Recommendations for Hydration, Cont.

• WHAT NOT TO DRINK
• Drinks with Carbohydrate (CHO)
  concentrations of greater than eight percent
  should be avoided.
• Fruit juices, CHO gels, sodas, and sports
  drinks that have a CHO greater than six to eight
  percent are not recommended during exercise as
  sole beverages.
• Beverages containing caffeine, alcohol, and
  carbonation are not to be used because of the
  high risk of dehydration associated with excess
  urine production, or decreased voluntary fluid
  intake.

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Recommendations for Hydration, Cont.

• WHAT TO DRINK DURING EXERCISE
• If exercise lasts more than 45-50 minutes
  or is intense, a sports drink should be provided
  during the session.
• The carbohydrate concentration in the ideal
  fluid replacement solution should be in the
  range of six to eight percent CHO.
• During events when a high rate of fluid
  intake is necessary to sustain hydration, sports
  drinks with less than seven percent CHO should be
  used to optimize fluid delivery. These sports
  drinks have a faster gastric emptying rate and
  thus aid in hydration.
• Sports drinks with a CHO content of 10
  percent have a slow gastric emptying rate and
  contribute to dehydration and should be avoided
  during exercise.
• Fluids with salt (sodium chloride) are
  beneficial to increasing thirst and voluntary
  fluid intake as well as offsetting the amount of
  fluid lost with sweat.
• Salt should never be added to drinks, and
  salt tablets should be avoided.
• Cool beverages at temperatures between 50
  to 59 degrees Fahrenheit are recommended for
  best results with fluid replacement.

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Asthma and Exercise

• Coaches, athletic trainers and other health care
  professionals should
• Be aware of the major signs and symptoms of
  asthma, such as coughing, wheezing, tightness in
  the chest, shortness of breath and breathing
  difficulty at night, upon awakening in the
  morning or when exposed to certain allergens or
  irritants.
• Devise an asthma action plan for managing
  and referring athletes who may experience
  significant or life threatening attacks, or
  breathing difficulties.
• Have pulmonary function measuring devices,
  such as peak expiratory flow meters (PFMs), at
  all athletic venues, and be familiar with how to
  use them.
• Encourage well-controlled asthmatics to
  engage in exercise to strengthen muscles, improve
  respiratory health and enhance endurance and
  overall well being.
• Refer athletes with atypical symptoms
  symptoms that occur despite proper therapy or
  other complications that can exacerbate asthma
  (e.g. sinusitis, nasal polyps, severe rhinitis,
  gastroesophageal reflux disease GERD or vocal
  cord dysfunction), to a physician with expertise
  in asthma. They include allergists, ear, nose and
  throat physicians, cardiologists and
  pulmonologists trained in providing care for
  athletes.

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Asthma and Exercise, Cont.

• Consider providing alternative practice
  sites for athletes with asthma. Indoor practice
  facilities that offer good ventilation and air
  conditioning should be taken into account for at
  least part of the practice.
• Encourage players with asthma to have
  follow-up examinations at regular intervals with
  their primary care physician or specialist. These
  evaluations should be scheduled at least every
  six to 12 months.
• Identify athletes with past allergic
  reactions or intolerance to aspirin or
  non-steroidal anti-inflammatory drugs (NSAIDs),
  and provide them with alternative medicines, such
  as acetaminophen.
• Be aware of Web sites that provide general
  information on asthma and exercise induced
  asthma. These sites include the American Academy
  of Allergy, Asthma and Immunology
  www.aaaai.org the American Thoracic Society
  www.thoracic.org the Asthma and Allergy
  Foundation of America www.aafa.org and the
  American College of Allergy, Asthma Immunology
  www.acaai.org

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Section 4

• Anabolic Steroids and
• Nutritional Supplements

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Illegal Steroid Use and Random Anabolic Steroid
Testing

• Texas state law prohibits possessing,
  dispensing, delivering or administering a steroid
  in a manner not allowed by state law.
• Texas state law also provides that bodybuilding,
  muscle enhancement or the increase in muscle bulk
  or strength through the use of a steroid by a
  person who is in good health is not a valid
  medical purpose.
• Texas state law requires that only a medical
  doctor may prescribe a steroid for a person.
• Any violation of state law concerning steroids
  is a criminal offense punishable by confinement
  in jail or imprisonment in the Texas Department
  of Criminal Justice.
• As a prerequisite to participation in UIL
  athletic activities, student-athletes must agree
  that they will not use anabolic steroids as
  defined in the UIL Anabolic Steroid Testing
  Program Protocol and that they understand that
  they may be asked to submit to testing for the
  presence of anabolic steroids in their body.
  Additionally, as a prerequisite to participation
  in UIL athletic activities, student-athletes must
  agree to submit to such testing and analysis by a
  certified laboratory if selected.

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Illegal Steroid Use and Random Anabolic Steroid
Testing, Cont.

• Also, as a prerequisite to participation by a
  student in UIL athletic activities, their parent
  or guardian must certify that they understand
  that their student must refrain from anabolic
  steroid use and that the student may be asked to
  submit to testing for the presence of anabolic
  steroids in his/her body. The parent or guardian
  also must agree to submit their child to such
  testing and analysis by a certified laboratory if
  selected.
• The results of the steroid testing will only be
  provided to certain individuals in the students
  high school as specified in the UIL Anabolic
  Steroid Testing Program Protocol which is
  available on the UIL website at
  www.uil.utexas.edu. Additionally, results of
  steroid testing will be held confidential to the
  extent required by law.

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Health Consequences Associated with Anabolic
Steroid Abuse

• In boys and men, reduced sperm production,
  shrinking of the testicles, impotence, difficulty
  or pain in urinating, baldness, and irreversible
  breast enlargement (gynecomastia).
• In girls and women, development of more masculine
  characteristics, such as decreased body fat and
  breast size, deepening of the voice, excessive
  growth of body hair, and loss of scalp hair.
• In adolescents of both sexes, premature
  termination of the adolescent growth spurt, so
  that for the rest of their lives, abusers remain
  shorter than they would have been without the
  drugs.
• In males and females of all ages, potentially
  fatal liver cysts and liver cancer blood
  clotting, cholesterol changes, and hypertension,
  each of which can promote heart attack and
  stroke and acne. Although not all scientists
  agree, some interpret available evidence to show
  that anabolic steroid abuse-particularly in high
  doses-promotes aggression that can manifest
  itself as fighting, physical and sexual abuse,
  armed robbery, and property crimes such as
  burglary and vandalism. Upon stopping anabolic
  steroids, some abusers experience symptoms of
  depressed mood, fatigue, restlessness, loss of
  appetite, insomnia, reduced sex drive, headache,
  muscle and joint pain, and the desire to take
  more anabolic steroids.
• In injectors, infections resulting from the use
  of shared needles or nonsterile equipment,
  including HIV/AIDS, hepatitis B and C, and
  infective endocarditis, a potentially fatal
  inflammation of the inner lining of the heart.
  Bacterial infections can develop at the injection
  site, causing paid and abscess.

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Nutritional / Dietary Supplements

• The contents and purity of nutritional / dietary
  supplements are NOT tested closely or regulated
  by the Food and Drug Administration (FDA).
• As such, UIL is making student athletes and
  parents aware of the possibility of supplement
  contamination and the potential effect on a
  student athletes steroid test. UIL does not
  approve or disapprove supplements.
• Contaminated supplements could lead to a positive
  steroid test. The use of supplements is at the
  student-athletes own risk. Student-athletes and
  interested individuals with questions or concerns
  about these substances should consult their
  physician for further information.
• Student athletes must be aware that they are
  responsible for everything they eat, drink and
  put into their body. Ignorance and/or lack of
  intent are not acceptable excuses for a positive
  steroid test result.
• The American College of Cardiology recommends
  that "Athletes should have their nutritional
  needs met through a healthy balanced diet
  without dietary supplements".

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• The National Center for Drug Free Sport, Inc. has
  partnered with the UIL to provide an easily
  accessible resource designed to answer questions
  about its drug-testing program, banned substances
  and inquiries about dietary supplements.
• The REC is available 24 hours a day seven days a
  week by calling the UIL hotline or going online
  and entering the assigned password. All
  correspondence with the REC can be done so
  anonymously, and will be kept confidential.
• The web address for The Resource Exchange Center
  (REC) is
• www.drugfreesport.com/rec
• The password to the REC for the Texas State High
  Schools texashs
• The toll free number to the REC for the UIL
  877-733-1135

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Section 5

• Lightning Safety

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Recommendations for Lightning Safety

• Establish a chain of command that identifies who
  is to make the call to remove individuals from
  the field.
• Name a designated weather watcher (A person who
  actively looks for the signs of threatening
  weather and notifies the chain of command if
  severe weather becomes dangerous).
• Have a means of monitoring local weather
  forecasts and warnings.
• Designate a safe shelter for each venue. See
  examples below.
• Use the Flash-to-Bang count to determine when to
  go to safety. By the time the flash-to-bang count
  approaches thirty seconds all individuals should
  be already inside a safe structure. See method of
  determining Flash-to-Bang count below.
• Once activities have been suspended, wait at
  least thirty minutes following the last sound of
  thunder or lightning flash prior to resuming an
  activity or returning outdoors.

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Recommendations for Lightning Safety, Cont.

• Avoid being the highest point in an open field,
  in contact with, or proximity to the highest
  point, as well as being on the open water. Do not
  take shelter under or near trees, flagpoles, or
  light poles.
• Assume that lightning safe position (crouched on
  the ground weight on the balls of the feet, feet
  together, head lowered, and ears covered) for
  individuals who feel their hair stand on end,
  skin tingle, or hear "crackling" noises. Do not
  lie flat on the ground.
• Observe the following basic first aid procedures
  in managing victims of a lightning strike
• Activate local EMS
• Lightning victims do not "carry a
  charge" and are safe to touch.
• If necessary, move the victim with
  care to a safer location.
• Evaluate airway, breathing, and
  circulation, and begin CPR if necessary.
• Evaluate and treat for hypothermia,
  shock, fractures, and/or burns.
• All individuals have the right to leave an
  athletic site in order to seek a safe structure
  if the person feels in danger of impending
  lightning activity, without fear of repercussions
  or penalty from anyone.

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Recommendations for Lightning Safety, Cont.

• Safe Shelter
• A safe location is any substantial, frequently
  inhabited building. The building should have four
  solid walls (not a dug out), electrical and
  telephone wiring, as well as plumbing, all of
  which aid in grounding a structure.
• The secondary choice for a safer location from
  the lightning hazard is a fully enclosed vehicle
  with a metal roof and the windows completely
  closed. It is important to not touch any part of
  the metal framework of the vehicle while inside
  it during ongoing thunderstorms.
• It is not safe to shower, bathe, or talk on
  landline phones while inside of a safe shelter
  during thunderstorms (cell phones are ok).
• Flash-to-Bang
• To use the flash-to-bang method, begin counting
  when sighting a lightning flash. Counting is
  stopped when the associated bang (thunder) is
  heard. Divide this count by five to determine the
  distance to the lightning flash (in miles). For
  example, a flash-to-bang count of thirty seconds
  equates to a distance of six miles. Lightning has
  struck from as far away as 10 miles from the
  storm center.
• Postpone or suspend activity if a thunderstorm
  appears imminent before or during an activity or
  contest (irrespective of whether lightning is
  seen or thunder heard) until the hazard has
  passed. Signs of imminent thunderstorm activity
  are darkening clouds, high winds, and thunder or
  lightning activity.

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Section 6

• Communicable Diseases

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Communicable Disease Procedures

• The risk for blood-borne infectious diseases,
  such as HIV/Hepatitis B, remains low in sports
  and to date has not been reported. However,
  proper precautions are needed to minimize the
  potential risk of spreading these diseases. In
  addition to these diseases that can be spread
  through transmission of bodily fluids only, skin
  infections that occur due to skin contact with
  competitors and equipment deserve close
  oversight, especially considering the emergence
  of the potentially more serious infection with
  Methicillin-Resistant Staphylococcus Aureus
  (MRSA).

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Communicable Disease Procedures, Cont.

• Universal Hygiene Protocol for All Sports
• Shower immediately after all competition
  and practice
• Wash all workout clothing after practice
• Wash personal gear, such as kneepads,
  periodically
• Don't share towels or personal hygiene
  products with others
• Refrain from (full body) cosmetic shaving

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Communicable Disease Procedures, Cont.

• Means of reducing the potential exposure to
  Infectious Skin Diseases include
• Notify guardian, trainer and coach of any
  lesion before competition or practice. Athlete
  must have a health-care provider evaluate lesion
  before returning to competition.
• If an outbreak occurs on a team, especially in
  a contact sport, consider evaluating other team
  members for potential spread of the infectious
  agent.
• Follow NFHS or state/local guidelines on "time
  until return to competition." Allowance of
  participation with a covered lesion can occur if
  in accordance with NFHS, state or local
  guidelines and is no longer considered contagious.

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Communicable Disease Procedures, Cont.

• Means of reducing the potential exposure to
  Blood-Borne Infectious Diseases include
• An athlete who is bleeding, has an open wound,
  has any amount of blood on his/her uniform or has
  blood on his/her person, shall be directed to
  leave the activity until the bleeding is stopped,
  the wound is covered, the uniform and/or body is
  appropriately cleaned and/or the uniform is
  changed before returning to competition.
• Certified athletic trainers or caregivers need
  to wear gloves and take other precautions to
  prevent blood-splash from contaminating
  themselves or others.
• Immediately wash contaminated skin or mucous
  membranes with soap and water.
• Clean all contaminated surfaces and equipment
  with disinfectant before returning to
  competition. Be sure to use gloves with cleaning.
• Any blood exposure or bites to the skin that
  break the surface must be reported and evaluated
  by a medical provider immediately.

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Sources

• American College of Cardiology
• California Interscholastic Federation
• National Athletic Trainers Association
• National Federation of State High School
  Associations
• National Institute on Drug Abuse
• Syracuse University
• Texas Education Agency
• University Interscholastic League